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Lord Chan: My Lords, I, too, thank the noble Lord, Lord Fowler, for giving us this opportunity to focus on HIV/AIDS, which is typically a sexually transmitted disease. It disproportionately affects the poorest people, with devastating results, in developing countries. I intend to focus on the integration of existing health services to help in particular children in developing countries—the 700,000 who were infected last year resulting in 500,000 deaths.
Globally, as the noble Lord, Lord Fowler, told us, between 40 million and 46 million individuals live with HIV, 95 per cent of them in developing countries. Africa is now the most affected continent, with 30 million in sub-Saharan countries where six in 10 sufferers are women.
Twenty-nine million people have died of AIDS so far, with 3 million dying last year. As most of the deaths occur in young adults, some 14 million children have lost at least one parent to HIV/AIDS. It is estimated that by 2010, 20 million children will have lost a parent from AIDS. That orphaning in highly affected countries may cause children to enter the labour market before they have completed school education and exacerbate problems of child labour. Financial help needs to be given to families where one or both parents have died of HIV/AIDS.
The low status of girls and women in many traditional societies in Africa and especially in Asia, has led to them being sold into prostitution, which in turn spreads HIV/AIDS faster and further in those countries. In India, where young women join the sex industry in metropolitan cities from poor rural communities, including from Nepal, HIV spreads to their home when they return with the disease. India
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now has between 4.58 million to 6 million living with HIV, a number that is second only to South Africa, as most of us are aware.
However, when I was working in India in the late 1980s and early 1990s, there was a denial that HIV and certainly AIDS were important. It was said that only a few thousand people were infected. Well, the figure has now grown to millions. Therefore, if all girls were educated in schools, they would be economically active without being exploited in the sex industry. Is that something in which we can encourage the international community to invest?
Some services which reduce the risk of HIV infection exist, but they are mainly for reproductive health and are not integrated with initiatives in HIV/AIDS. Because poor developing countries cannot afford to establish a separate service for sexually transmitted infections, particularly because of the stigma, integration of reproductive health services with HIV would seem to be logical and economically sound. Services such as maternal and child health clinics that incorporate family planning information and supplies of condoms could also identify mothers with HIV and provide them and their babies with anti-retroviral drugs to prevent the new-born babies from becoming infected. Improving reproductive health services is essential to combating HIV/AIDS through HIV counselling, increased condom availability for use by men and also condoms for women through the management of sexually transmitted infections.
Teams that treat malaria in endemic areas are becoming another avenue of tackling HIV and associated infections such as tuberculosis. These teams give anti-malarial medicines after testing the patient's blood for malarial parasites. Blood can also be collected to screen for HIV and implement treatment. When providing advice on how to prevent children from being bitten by malaria-carrying mosquitoes, information on how to avoid sexually transmitted infections can also be given to the community. As chairman of a charity, the Malaria Consortium, I am encouraged by these positive developments to integrate the management of malaria and HIV in our African field areas in Uganda and in Ghana by local health teams. In addition, treatment for TB is given where required. We are monitoring the implementation of these programmes and collecting data.
The All-Party Parliamentary Group on AIDS, of which I am a member, is particularly concerned about the rapidly emerging epidemics in eastern Europe and central Asia that have been identified by other noble Lords. The enormous growth of HIV in these countries cannot possibly be due only to better detection and is clearly a result of the rapid spread of HIV infection. This rapid infection rate will reduce economic growth by 1 per cent as spending on health in these countries on HIV/AIDS increases from 1 to 3 per cent of gross domestic product.
When the HIV infection rate has increased beyond 1 per cent among adults, no country has been able to contain the epidemic. Russia is now approaching that 1 per cent threshold.
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The Chinese Government estimate that there are 840,000 HIV-positive people in their country and that 80,000 have AIDS. The UN estimates that there are at least 1 million people with HIV in China and that this number could grow to 20 million by 2010. That is probably a more realistic estimate than that of the Chinese Government because only 10 per cent of individuals in China know that they are infected with HIV.
About 7.2 million people in Asia are HIV positive, with 5 million living in India and China. An estimated 500,000 people died of AIDS-related complications in Asia in 2002. The growing epidemic in Asia accounts for approximately 25 per cent of the world's new cases of HIV/AIDS.
I know that the Department for International Development is consulting on its future programme for HIV/AIDS in developing countries. DfID has done, and continues to do, effective work to combat HIV/AIDS—something of which we can all be proud. Perhaps the Minister would consider international plans to control the spread of HIV/AIDS in Asia through education, capacity building and support for the treatment and prevention of this serious disease.
In partnership with local mass media, information can be given to all communities about the dangers of HIV/AIDS and about how to avoid infection. In 2002, the BBC World Service assisted All India Radio and Doordarshan TV in disseminating information on HIV/AIDS. It was aimed at young people in northern India and information was given on how they could protect themselves and end discrimination against those living with AIDS. Is the Minister aware of any other partnerships along those lines in other parts of Asia?
Finally, some developing countries in Africa and south-east Asia have begun to assess the effect of their local and national programmes for reducing the spread of HIV/AIDS. Uganda and Thailand, which have already been mentioned, have made progress in combating HIV/AIDS. Will Her Majesty's Government encourage and assist developing countries in learning good practice from other countries in their region or continent? Such learning would be more appropriate than using models that work in industrialised countries.
Lord St John of Bletso: My Lords, it is a pleasure to follow my noble friend Lord Chan with his distinguished international medical career. I join in thanking the noble Lord, Lord Fowler, for introducing this debate on the worldwide HIV/AIDS pandemic.
We are all acutely conscious of the gravity of the situation in many parts of the world but, among the cacophony of statistics and projections, I was particularly moved by a recent report by Stephen Lewis, the United Nations Secretary-General's special envoy on HIV/AIDS in Africa. He was visiting a paediatric ward in Lusaka last year where doctors told him that, in that hospital alone, a child dies of HIV/
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AIDS-related causes every 15 minutes. I fear that such situations are duplicated in many other hospitals, particularly in southern Africa. This is not about sterile statistics; this crisis is about human suffering on an almost unimaginable scale. Therefore, I thank the noble Lord, Lord Fowler, for once again bringing this issue to your Lordships' attention.
Much is being done, and many new initiatives and projects are being launched month on month. The noble Baroness, Lady Jay, and the noble Lord, Lord Holme, will be co-chairing an important workshop on HIV/AIDS in southern Africa at Marlborough House tomorrow. As the noble Lord, Lord Fowler, mentioned in his powerful speech, this pandemic is a global problem. However, I should like to focus my remarks today on the serious situation in South Africa—a country in which I have spent most of my life.
In South Africa, where the Minister of Health has long been extolling the medicinal qualities of olive oil, lemon, garlic and the African potato, the Government last November eventually—I stress, eventually—agreed to start the distribution of anti-retroviral drugs to patients with a CD count below 200. Almost 15,000 patients are now receiving this form of treatment, which will save some lives and certainly extend many others. This is a welcome start.
I had lunch yesterday with the governor of the Reserve Bank of South Africa, Tito Mboweni, who confirmed that the South African Government have committed themselves to spending 12 billion rand on the struggle against HIV/AIDS over the next five years. This massively increased health budget, combined with the billions of dollars in aid from other countries—most notably, the United States and Britain—should maintain the delivery of anti-retroviral drugs nationwide.
Incidentally, while this debate focuses on HIV/AIDS, we should be mindful that it is not the only killer disease in Africa. I was pleased that my noble friend Lord Chan mentioned the scourge of malaria. More than 350 million Africans—nearly half the population—contract malaria every year, and yet malaria medication is not proclaimed a basic human right. As my noble friend Lord Sandwich quoted, one in three people living with HIV worldwide are co-infected with tuberculosis, and nine out of 10 die of TB within a few months unless treatment is available. Spending on HIV/AIDS research currently exceeds spending on TB by a factor of 90 to one.
Aside from caring for the suffering of HIV/AIDS patients, it is also important to focus funds on the whole issue of prevention. In this regard, it is encouraging to see the South African Government and private enterprise there combining to warn and inform the population. That prevailing resolve was reflected by Mbhazima Shilowa, the Premier of Gauteng, the former Transvaal, when he said last month:
The "Love Life" campaign has been spread across roadside billboards, candidly advocating safe sex and urging self-preservation. The Kaiser Foundation has
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put 500 million rand into a youth prevention campaign, and various British NGOs are making an invaluable contribution to this cause. Recent findings of the Reproductive Health Research Unit at the University of the Witwatersrand suggest that such measures are starting to produce positive results. The survey of 12,000 young people aged between 15 and 25 found that 32 per cent regularly use condoms—up from 8 per cent in 1998. It also suggests that the infection rate among 15 to 19 year-olds is slowing.
There are positive indicators in what otherwise remains an extremely bleak situation. HIV/AIDS awareness remains almost non-existent in urban squatter camps and rural areas, and the alarming rate of infection among South African youth remains the highest in the world. More campaigns and more programmes are required to address persistent behavioural trends, such as multiple sexual partners and alcohol and drug abuse. I entirely agree with the call of the right reverend Prelate the Bishop of Salisbury that the threat of the pandemic should be preached in churches, mosques and other religious forums.
Of course, there remains a great deal to be done but, 12 months ago, South Africa appeared to be sleepwalking to disaster. That is thankfully not the case today. At long last, the tide has started to turn. I would, however, like to sound a note of caution on the accuracy of the available statistics. Many of your Lordships will be aware of the recent report by UNAIDS, which estimated that 5.4 million South Africans have been infected by HIV—that is, one in every nine of the 45 million. It has also been reported that the HIV/AIDS virus is carried not only by 100,000 of the country's 1 million civil servants but also by a quarter of mineworkers employed by Anglo American.
I challenge how these noticeably round numbers are calculated. Like anything else, they should be subject to scrutiny. Estimates of infection and death rates are based not on the results of actual testing, which are costly and clearly impractical, but on sparse information fed into computer models. Such systems are patently imperfect.
The World Health Organisation initially used Epimodel to calculate that 250,000 South Africans had died of HIV/AIDS related causes in 1999. This system was subsequently upgraded to ASSA 600, which concluded that only 143,000 South Africans had died because of the virus in 1999. Towards the end of 2001, the agency then introduced another model, ASSA 2000, which further reduced the total to 92,000.
Of course, we must take the statistics seriously, but they are estimates, not facts. Last year, it was widely reported that the population of Botswana had fallen from 1.4 million to below 1 million because of HIV/AIDS related deaths. However, a recent census put the population at 1.7 million.
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The HIV/AIDS pandemic remains an immense problem in southern Africa. However, the campaign to control the virus in South Africa and Botswana is, thankfully, starting to make headway. I hope that the focus remains as firmly on prevention as on cure.
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